Request a Certificate

If this is an after-hours “rush” certificate request, please call Suzanne L’Hussier at 978-828-5277

For your certificate request, please contact:

Theresa Stickney, CIC, CISR
Commercial Lines Division Manager
Call: 978-256-3180
Fax: 978-250-8378
Email: Theresa@lhussierins.com

Date*
Month
Day
Year
Name of Insured*
Name of Certificate Holder*
Address of Certificate Holder*
Street Address Address Line 2 City State ZIP Code
Email*
Phone Number
Fax Number
Is there any party requesting to be an additional insured?
- Yes
- No
Additional Insured's Interest
Additional Insured's Job/Property Name
Additional Insured's Location/Address
Street Address Address Line 2 City State ZIP Code
Special Requirements
Comments/Instructions
Preferred Method of Delivery
- Fax Number
- Postal Mail
- E-Mail Address